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Medicare Advantage Lead Medical Director in Chattanooga, TN

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compensation:

$200K - $250K*

specialty:

Medicine, Healthcare Management

experience:

5 - 7 years

Job Description

Provides clinical leadership and serves as an internal medical consultant to various divisions and committees to support the development, implementation and monitoring of medical management and quality improvement activities.Job Description:

Job Responsibilities


  • Develop and administer inter-reviewer reliability methodology to ensure medical necessity determinations are consistent with CMS published guidelines corporate medical review criteria, and medical policy guidelines.
  • Analyze, evaluate and apply clinical metrics that produce actionable information in support of medical management and quality improvement initiatives.
  • Direct and support physician review to ensure timeliness, accuracy and reliability of UM and Appeals reviews.
  • Lead and serve on various committees in order to accomplish medical utilization, cost and quality objectives of BCBST.
  • Willingness to travel within the State of Te
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Valid through: 2020-5-20

About BlueCross BlueShield of Tennessee

BlueCross BlueShield of South Carolina (BCBSSC) is an independent licensee of the Blue Cross and Blue Shield Association. BCBSSC serves 21.5 million people through private business and government contracts. BCBSSC has several subsidiaries, two of which are affiliates licensed with the Blue Cross and Blue Shield Association. Licensed subsidiaries include BlueCross BlueShield of South Carolina Foundation and BlueChoice HealthPlan. Non-licensed affiliates include Companion Captive Insurance Company, Companion Life, PGBA, LLC, Planned Administrators, Inc. (PAI) and TCC of South Carolina. BCBSSC began as the South Carolina Hospital Service Plan, later becoming BlueCross of South Carolina (BlueCross), when the General Assembly passed legislation bringing this group into existence. In the spring of 1947, the South Carolina Hospital Service Plan merged with the Hospital Benefit Association of Greenville, giving them a financial base. In 1971, BlueShield of South Carolina merged with BlueCross to form the current company.
Total Jobs:
33
Total Experts:
15
Average Pay:
$122,717
Total value of jobs:
$16,935,000
% Masters:
43%

BlueCross BlueShield of Tennessee Photos

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* Ladders Estimates

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